Kate Whetten, Ph.D., M.P.H.
Director, Duke University Health Inequalities Program

HIV in Rural Towns

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Twenty years ago, you probably wouldn't have found people with HIV in small-town North Carolina. In the early days, it was a big city problem. But today, in the new age of HIV/AIDS, specialists say the virus has invaded tiny towns, quiet countrysides, and every corner of our state. Statistics show about 25-percent of the state's HIV and AIDS cases are in rural areas, and researchers say people there face a special set of challenges, the biggest being stigma and discrimination.

"The town's beautiful. It's a beautiful town. Of course it's like any other southern town, it's driven by religion and politics," says ‘Jason,' an HIV positive man who wants to stay anonymous because he fears repercussions to his family in the small town where they live.

"I think probably good ole boys would drive by and yell a few words, and the children would probably hear quite a bit at school," Jason says.

Plus, he says, there's little assistance or medical care for him or for the other HIV positive men and women all across rural North Carolina.

"Options are at a minimal," he explains. "You have one doctor or one group of doctors. That's it. In the larger cities I would have a choice of 15, 20 and would not have to commute as far."

Jason's case manager, Ramya Gleeson, is based almost an hour away in Asheville, which is also where the doctors are. She says transportation to and from the city is just part of the battle.

"You're not just addressing the HIV, you're trying to reduce stress factors in a person's life," Gleeson says. "And that can involve looking at food, housing, utilities, transportation, medical care."

"The men and the women we talked to were thinking about how to get food on the table, how to get electricity, basic living needs, and so it started to make sense why HIV was perhaps not the most important thing in their lives," says Dr. Kate Whetten of Duke University. "As one person said, it was the icing on the cake of a bad life."

Dr. Whetten runs the health inequalities program at Duke University and wrote the book You're The First One I've Told about people living with HIV and AIDS in rural North Carolina. She says the single largest barrier facing people with HIV in rural North Carolina is the stigma that still surrounds the disease.

"You can give them brochures about HIV and their medications and things in the clinics, but when they get back to their town they need to throw those away, so stigma is an incredible barrier," Dr. Whetten says.

Jason doesn't even go to the clinic in his town because he's afraid someone will find out.

"Pretty much the backlash on my children," he says. "I'm more afraid of them being discriminated against or teased or whatever for something I did prior to them."

"We had a woman who can't sit on her porch anymore because people drive by and throw cans at her and call her the AIDS lady," says Dr. Whetten. "For rural areas until we can attack the stigma about this disease, it's going to be very hard to keep people on their medications, to get care and to prevent the spread of the disease because people don't know their neighbors are positive ... We need to stop looking at people who are HIV positive as people who have done something wrong. We need to look at them as people who are chronically ill."

"I think education needs to happen in the rural communities," Gleeson says. "It's been a very difficult community to create awareness in, on all levels, from the medical providers to the church groups to the neighborhoods and to the schools."